Administrator: Susan Anello, RN, CNOR, CPSN
Director: Scott Newman, MD, FACS
Types of surgeries: Cosmetic/plastic
Staff: 7 - 1 doctor, 2 RNs, 1 RN, CNOR, CPSN, 3 office
Procedure rooms: 3
ORs: 1
Operating surgeons: 1
Monthly case volume: 30
Years in operation: 9
Ownership structure: Corporation

Designing a new office
Scott Newman, MD, FACS, paid special attention to maximizing storage space and patient flow when he designed and relocated his plastic surgery center to Yonkers, N.Y., in January 2002. Some noteworthy design elements in the 5,000-square-foot facility include storage closets built into the OR walls, sliding doors that separate the OR and the recovery room that sits across the hall, and chic and plush waiting rooms featuring large couches, Oriental blinds and original art. "It's designed to be comfortable and stylish," says administrator Susan Anello, RN, CNOR, CPSN. "There's a commercial aspect to a cosmetic surgery practice."

Fighting the city bureaucracy
The setting of his new office is "ideal" - a customized, ground-level facility in an executive park one block from St. John's Riverside Hospital - with one exception. The city of Yonkers won't let Dr. Newman put up a sign outside his office unless he gets a zoning variance. His concern is that, if a patient ever were to require transport to the hospital, an ambulance might not be able to find his office because its exterior is so non-descript. "The city has to allow for safety issues," says Dr. Newman. "We'll get the variance for the sign. It's just another hassle - these are the things that make medicine a business."

Earning dual certification
The office-based center has been AAAASF-certified for a year and on April 1 became the 100th office-based surgery center to earn JCAHO accreditation. Dr. Newman decided while designing the new facility that the accreditation process would go more smoothly if the office was built to comply with AAAASF requirements - especially the ones that are potentially expensive to change later, such as making sure the right types of carpeting and ceiling tiles were installed. "If it's going to be built," says Dr. Newman, "why not build it so it would comply with all the regulatory standards?"

Not long after he earned AAAASF certification, Dr. Newman decided to go for the JCAHO seal, too, because, he says, the two accreditations complement each other. "For example, AAAASF requires a thermometer in the medication refrigerator," says Dr. Newman. "JCAHO is not just concerned with having the thermometer in there, but in addition they want to know: What's the regular temperature? Is it working? How do you know if power was lost then came back on over night? From the perspective of creating a facility that is safe, they're both important."

Waiting on unknown costs
For all the positives of JCAHO certification, there has been one pitfall: unknown costs. The center must now keep all anesthesia medications on site - something they, like most office-based centers that contract with anesthesiologists who bring the medications with them, weren't previously doing.

"That's a major change, especially keeping track of it," says Ms. Anello. "It's something I hadn't anticipated. It was a large financial outlay initially. We're going to have to see how that plays out."

- Stephanie Wasek